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  • 1.
    Andersson, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Terapeuter rapporterar om bildterapi i fallstudier2015Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [en]

    Aims: The aim of this study has been first to investigate whether common characteristics exist in the field of art therapy or not, and second to illustrate the way art therapists write reports about their sessions.

    Methods: A literature study was made. Ten case studies were selected and analysed.

    Results: The results of the study showed that the art therapists often went beyond the concepts of the traditional therapy room and of materials used in their sessions. The results also showed shortcomings in the way art therapists reported.

    Conclusion: Art therapists need to refine and develop their way of writing reports in order for these reports to become more scholarly. Both general studies and investigations of more depth are needed to confirm or falsify the results of this study.

  • 2.
    Andersson, Lina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Brannelid, Maria
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Kylda matlådor inom äldreomsorgen: En studie om kundernas upplevelse kring beställning, leverans och mat2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Background"Food is more than just the amount of food you eat” read the headline on an article from Skåne magazine from January 2014. The article arose because of the criticism levelled against the refrigerated lunch boxes served in senior care. The lunch boxes that were send to the elderly people were not assessed for nutrient content so there could be a lack of nutrients in the boxes. There were also a lack of procedures and controls, to show how much of the food they ate. Not getting enough nutrients and energy can lead to complications such as impaired immune system and depression.

     

    Objective The purpose of the study was to find out how customers in senior care in a selected municipality in the middle of Sweden experienced ordering, delivery, and the food that the municipality distributed them.

     

    Method A questionnaire was designed in collaboration with the dietician at the selected municipality. During the spring of 2014 170 questionnaires were distributed. It was calculated median and mean some of the results were compared with previous studies conducted in the municipality.

     

    Results From the 170 questionnaires sent out 89 samples were returned. The study came to consist of 39 male and 49 women. The informants felt overall that the food tasted good and they were satisfied with the order, delivery and food. There was some differences between the genders, men were more satisfied then the women.

     

    Conclusion The study shows that the customers in the municipality overall were satisfied with the lunch boxes. No major changes had occurred since previous studies carried out in the municipality. This indicates that the food was of good standard. What we saw in the comments were that the costumers were complaining about the vegetables that are included in the lunch boxes.  We believe that these complaints need to be resolved by the municipality. We also believe that further studies should be conducted to get at deeper picture of the consumers food experience. 

  • 3.
    Andersson, Linus
    et al.
    Department of Occupational and Public Health Sciences, University of Gävle.
    Claeson, Anna-Sara
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Dantoft, Thomas Meinertz
    Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark.
    Skovbjerg, Sine
    Danish Research Centre for Chemical Sensitivities, Copenhagen University Hospital Gentofte.
    Lind, Nina
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Chemosensory perception, symptoms and autonomic responses during chemical exposure in multiple chemical sensitivity2016In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 89, no 1, p. 79-88Article in journal (Refereed)
    Abstract [en]

    Purpose: Multiple chemical sensitivity (MCS) is a prevalent medically unexplained symptom characterized by symptom reactions to everyday chemical exposure below hygienic thresholds. The aim of this study was to investigate the expressions of hyper-reactivity in MCS during whole-body exposure to low concentrations of the odorant n-butanol.

    Methods: We exposed 18 participants with MCS and 18 non-ill controls to a low concentration of the odorantn-butanol using an exposure chamber. The first 10 min constituted blank exposure, after which then-butanol concentration increased and reached a plateau at 11.5 mg/m3.

    Results: MCS participants, compared with controls, reported greater perceived odor intensities, more unpleasantness to the exposure and increasing symptoms over time. MCS participants also expressed higher pulse rate and lower pulse rate variability than controls did. No group differences were found for breathing rate or tonic electrodermal activity responses.

    Conclusions: We conclude that MCS sufferers differ from healthy controls in terms of autonomic responses, symptoms and chemosensory perception during chemical exposure.

  • 4.
    Bengtsson, Sara K S
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Johansson, Maja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Umecrine Cognit AB, Umea, Sweden.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Long-term continuous allopregnanolone elevation causes memory decline and hippocampus shrinkage, in female wild-type B6 mice2016In: Hormones and Behavior, ISSN 0018-506X, E-ISSN 1095-6867, Vol. 78, p. 160-167Article in journal (Refereed)
    Abstract [en]

    Chronic stress in various forms increases the risk for cognitive dysfunction, dementia and Alzheimer's disease. While the pathogenesis behind these findings is unknown, growing evidence suggests that chronic increase in neurosteroid levels, such as allopregnanolone, is part of the mechanism. We treated wild-type C57BL/6J mice with allopregnanolone for 5months, using osmotic pumps. This treatment led to moderately increased levels of allopregnanolone, equivalent to that of mild chronic stress. After an interval of no treatment for 1month, female mice showed impaired learning and memory function in the Morris water maze (MWM) in combination with diminished hippocampus weight and increased cerebellum weight, both correlating to MWM performance. Male mice showed a minor reduction in memory function and no differences in brain structure. We conclude that chronic allopregnanolone elevation can lead to cognitive dysfunction and negative brain alterations. We suggest that allopregnanolone could play a key role in the pathogenesis of stress-induced cognitive disturbances and perhaps dementia.

  • 5.
    Bergström, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Persson, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Sick leave and healthcare utilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum2016In: Chiropractic and Manual Therapies, ISSN 2045-709X, E-ISSN 2045-709X, Vol. 24, article id 7Article in journal (Refereed)
    Abstract [en]

    Background: Pregnancy related low back pain (PLBP) and pelvic girdle pain (PGP) are considered common complications of pregnancy. The long-term consequences for women with persistent PLBP/PGP postpartum are under-investigated. The main objective was to investigate the prevalence, pattern and degree of sick leave as well as healthcare utilisation and its perceived effect in women with persistent PLBP/PGP at 12 months postpartum.

    Method: This is a follow-up study of a cohort involving of a sample of women, who delivered from January 1st 2002 to April 30th in 2002 at Umea University Hospital and Sunderby Hospital, and who reported PLBP/PGP during pregnancy. A total of 639 women were followed-up by a second questionnaire (Q2) at approximately 6 months postpartum. Women with persistent PLBP/PGP at the second questionnaire (N = 200) were sent a third questionnaire (Q3) at approximately 12 months postpartum.

    Results: The final study sample consisted of 176 women reporting PLBP/PGP postpartum where N = 34 (19.3 %) reported 'no' pain, N = 115 (65.3 %) 'recurrent' pain, and N = 27 (15.3 %) 'continuous' pain. The vast majority (92.4 %) of women reported that they had neither been on sick leave nor sought any healthcare services (64.1 %) during the past 6 months at Q3. Women with 'continuous' pain at Q3 reported a higher extent of sick leave and healthcare seeking behaviour compared to women with 'recurrent' pain at Q3. Most women with persistent PLBP/PGP had been on sick leave on a full-time basis. The most commonly sought healthcare was physiotherapy, followed by consultation with a medical doctor, acupuncture and chiropractic.

    Conclusion: Most women did not report any sick leave or sought any healthcare due to PLBP/PGP the past 6 months at Q3. However, women with 'continuous' PLBP/PGP 14 months postpartum did report a higher prevalence and degree of sick leave and sought healthcare to a higher extent compared to women with 'recurrent' PLBP/PGP at Q3. Women with more pronounced symptoms might constitute a specific subgroup of patients with a less favourable long-term outcome, thus PLBP/PGP needs to be addressed early in pregnancy to reduce both individual suffering and the risk of transition into chronicity.

  • 6.
    Boström, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial2016In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 31, no 8, p. 868-878Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia.

    METHODS: Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini-Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45 min every other weekday for 4 months. The 15-item Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7 months.

    RESULTS: No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7 months. Among participants with GDS scores ≥ 5, reductions in GDS score were observed in the exercise and control groups at 4 months (-1.58, P = 0.001 and -1.54, P = 0.004) and 7 months (-1.25, P = 0.01 and -1.45, P = 0.007). Among participants with MADRS scores ≥ 7, a reduction in MADRS score was observed at 4 months in the control group (-2.80, P = 0.009) and at 7 months in the exercise and control groups (-3.17, P = 0.003 and -3.34, P = 0.002).

    CONCLUSIONS: A 4-month high-intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non-exercise group activities may reduce high levels of depressive symptoms.

  • 7.
    Byenfeldt, Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Faktorer som kan påverka mätresultaten vid shear wave elastografi av lever. En litteraturstudie.2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Hepatitis B and hepatitis C virus causes inflammation of the liver which can lead to fibrosis development, liver cirrhosis, chronic liver inflammation and liver cancer. Assessments of each patient’s progression of fibrosis are important for start of treatment on time and avoid the development of severe liver disease and in the worst cases, hepatocellular carcinoma (HCC). It is therefore of great importance that these patients are monitored and that patients' liver fibrosis development is continuously monitored and graded. Shear wave elastography (SWE) of the liver is a new technology that easily can be performed in conventional ultrasound. SWE has both nursing and medical advantages compared to liver biopsy and transient elastography (TE) with FibroScan®, making it reasonable to assume that there are also economic benefits and resources to save. However, there are factors that affect the result in SWE and these factors have been investigated in several studies. Aim: The aim of the study was to identify factors that may influence the result with shear wave elastography of the liver. Methods:  The study is a literature review where 22 quantitative articles, published between the years 2010 to 2015, were studied. Searches were made in four databases with keywords elasticity imaging techniques, shear wave and ultrasound elastography. Results: The study was able to identify several factors that may influence the result, which should be considered before determining the degree of fibrosis of the liver. These factors were in this study divided into two domains; factors related to the patient as well as factors related to technology and analysis of measurement results. Conclusion: This review is of great importance for radiography when a large number of factors that may influence the measuring result with SWE of the liver were identified. It is very important that these factors are considered before determining the degree of fibrosis in the liver.

  • 8.
    Calander, Björn
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    The effects of Clopidogrel on neuroinflammation and learning impairment related to Alzheimer´s disease2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Neuroinflammation has been intensively studied the last two decades and has been shown to take part in neurodegenerative diseases such as Alzheimer’s disease (AD). The microglial cells, which are macrophages of the central nervous system (CNS), are the main actors in this chronic inflammatory state. Together with the neurons, the microglia are thought to control the complex dynamic remodeling of neuronal dendrites and synapses seen during both healthy and pathologic conditions. As a surface receptor of microglia, the purinergic receptor P2Y12 transmits intracellular signals for their chemotaxis towards tissue damage within the CNS. Clopidogrel, which is an inhibitor of P2Y12, is prescribed to patients with cerebrovascular diseases, which have high comorbidity with AD. In the present study, upregulated motor behavior, sensitization, has been studied in amyloid-beta (Aβ)-injected zebrafish larvae as a model for cognitive decline in AD. Although the behavioral experiments indicated a protective effect on learning from Clopidogrel in Aβ-injected fish, this effect was not reaching significance when several experiments were pooled together. Neuronal cell death numbers measured by confocal imaging showed an increase in Aβ-injected zebrafish larvae when treated with Clopidogrel. In conclusion, the experiments show that P2Y12 is important for removal of dead cells in the CNS of larval zebrafish following injury, and therefore could be relevant for neurodegenerative processes in humans.

  • 9.
    Carstensen, Emil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Prevalence, trends and socioeconomic and demographic risk factors for self-reported diabetes in adults in Northern Sweden2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 10.
    Diderichsen, Saima
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    It's just a job: a new generation of physicians dealing with career and work ideals2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance.

    Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting.

    Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV).

    In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage.

    In paper II, five classes of final-year medical students  were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression.

    In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250),  and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results.

    In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology.

    Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives.

    The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest.

    Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting.

    Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions.

    Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties. 

  • 11.
    Eriksson Sörman, Daniel
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundström, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Rönnlund, Michael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nilsson, Lars-Göran
    Department of Psychology, Stockholm University, Sweden .
    Leisure Activity in Old Age and Risk of Dementia: a 15-Year Prospective Study2014In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 69, no 4, p. 493-501Article in journal (Refereed)
    Abstract [en]

    Objectives. The aim of this study was to investigate whether leisure activity is associated with incident dementia in an older sample.

    Method. We examined a sample of 1,475 elderly (>= 65 years) who were dementia free at baseline over a follow-up period of up to 15 years. In addition to analyses involving the total time period, separate analyses of three time periods were performed, 1-5, 6-10, and 11-15 years, following baseline measurement of leisure activity.

    Results. After controlling for a variety of potential confounders, analyses of data for the total time period revealed that higher levels of "Total activity" and "Social activity," but not "Mental activity," were associated with decreased risk of dementia. However, analyses of the separate time periods showed that this association was only significant in the first time period, 1-5 years after baseline.

    Discussion. The results from this study provide little support for the hypothesis that frequent engagement in leisure activities among elderly serve to protect against dementia diseases across a longer time frame. The finding of a relationship for the first time period, 1-5 years after baseline, could indicate short-term protective effects but could also reflect reverse causality.

  • 12. Godbolt, Alison K
    et al.
    Lindgren, Marie
    Stenberg, Maud
    Norrlands universitetssjukhus.
    Cronberg, Tobias
    Tengvar, Christer
    Sörbo, Ann
    Långvarig svår medvetandestörning efter hjärnskada hos vuxna: nya rekommendationer ger underlag för utredning och rehabilitering2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 49-50, p. 2230-2234Article in journal (Refereed)
    Abstract [en]

    After severe acquired brain injury some patients develop a prolonged disorder of consciousness (vegetative state or minimally conscious state), and as such cannot actively participate in neurorehabilitation. However, international opinion and recent research developments emphasize the need for involvement of rehabilitation medicine units in the care of these patients. The article presents recommendations for the care of adult patients with prolonged disorders of consciousness, which have been developed by a multidisciplinary working party, in order to promote good care, and identify areas for further improvements.

  • 13.
    Goicolea, Isabel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Marchal, Bruno
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Searching for best practices of youth friendly services - a study protocol using qualitative comparative analysis in Sweden2016In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, article id 321Article in journal (Refereed)
    Abstract [en]

    Background: Swedish youth clinics constitute one of the most comprehensive and consolidated examples of a nationwide network of health care services for young people. However, studies evaluating their 'youth-friendliness' and the combination of factors that makes them more or less 'youth-friendly' have not been conducted. This protocol will scrutinise the current youth-friendliness of youth clinics in northern Sweden and identify the best combination of conditions needed in order to implement the criteria of youth-friendliness within Swedish youth clinics and elsewhere.

    Methods/design: In this study, we will use qualitative comparative analysis to analyse the conditions that are sufficient and/or necessary to implement Youth Friendly Health Services in 20 selected youth-clinics (cases). In order to conduct Qualitative Comparative Analysis, we will first identify the outcomes and the conditions to be assessed. The overall outcome - youth-friendliness - will be assessed together with specific outcomes for each of the five domains - accessible, acceptable, equitable, appropriate and effective. This will be done using a questionnaire to be applied to a sample of young people coming to the youth clinics. In terms of conditions, we will first identify what might be the key conditions, to ensure the youth friendliness of health care services, through literature review, interviews with professionals working at youth clinics, and with young people. The combination of conditions and outcomes will form the hypothesis to be further tested later on in the qualitative comparative analysis of the 20 cases. Once information on outcomes and conditions is gathered from each of the 20 clinics, it will be analysed using Qualitative Comparative Analysis.

    Discussion: The added value of this study in relation to the findings is twofold: on the one hand it will allow a thorough assessment of the youth-friendliness of northern Swedish youth clinics. On the other hand, it will extract lessons from one of the most consolidated examples of differentiated services for young people. Methodologically, this study can contribute to expanding the use of Qualitative Comparative Analysis in health systems research.

  • 14. Hellström, Fredrik
    et al.
    Gouveia-Figueira, Sandra
    Umeå University, Faculty of Science and Technology, Department of Chemistry. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Nording, Malin L.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research, University of Gävle, Sweden.
    Fowler, Christopher J.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Association between plasma concentrations of linoleic acid-derived oxylipins and the perceived pain scores in an exploratory study in women with chronic neck pain2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, article id 103Article in journal (Refereed)
    Abstract [en]

    Background: Chronic musculoskeletal pain may be associated with changes in the balance of algogenic and anti-nociceptive compounds, and such changes may be visible in plasma samples. We have undertaken an exploratory study to measure the levels of endocannabinoids, related N-acylethanolamines and oxylipins (primarily those derived from linoleic acid) in plasma samples from women with chronic neck pain (NP) and chronic widespread pain (CWP), and to investigate whether the observed levels are associated with the pain experienced by these women.

    Methods: Blood samples from 35 women with NP, 15 with CWP and 27 age-matched controls were analysed for the lipids using ultra performance liquid chromatography coupled to tandem mass spectrometry. Current pain (“NRSday”) and the average pain during the last week (“NRSweek”) were rated by the participants using a numerical rating scale.

    Results: There were no significant differences in the plasma concentrations of the fifteen lipids investigated between the women with pain and the controls. However, significant correlations were seen for the NP group between the NRSday scores and the plasma concentrations of the linoleic acid derivatives 9- and 13-hydroxy-octadecadienoic acid (Spearman’s rho values 0.51 [P = 0.0016]) and 0.53 [P = 0.0011], respectively).

    Conclusions: The data obtained in this exploratory study indicate that although no group differences are seen in plasma lipid concentrations, there is an association between the NRSday scores and the 9- and 13-hydroxy-octadecadienoic acid levels. Whether or not the association reflects a causality (i.e. that the circulating lipids contribute to the perceived pain of the pain participants), requires further investigation.

  • 15.
    Hirvelä, Timo
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Are doctors and assistant nurses equally good at informing patients? A randomized controlled trial comparing information recall regarding postoperative self-care.2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 16.
    Hägg, Hampus
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patienters upplevelser av en magnetkameraundersökning2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Magnetic resonance imaging (MRI) is a frequently used medical imaging technique. It has the great advantage of not exposing the patient to ionizing radiation. The radiographer is responsible for the safety during the scanning- procedure. It is important that the radiographer has good knowledge of the patients’ experiences of both the MRI scanning procedure and the preparations. Aim: The aim of this study is to examine patients' experiences of an MRI-scan. Method: This work is a qualitative literature study. Searches for articles suitable for inclusion were made in the research databases CINAHL and Scopus. Eight articles fulfilling the inclusion criteria were found and the content was further analysed to identify categories. Result: Five categories summarizing patients’ experiences of an MRI-scan were identified: anxiety and fear; preceding information; communication; feelings, frame of mind and copingstrategies and waiting for results. Conclusion: The design of the MRI-scanner and the information and communication during the procedure affect the patients' experiences of the examination. It was shown that the radiographers treatment of the patient was of significance. Keywords: Magnetic resonance imaging, communication, patients' experiences, anxiety, radiographer

  • 17.
    Jonasson, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vänman, Emma
    Umeå University, Faculty of Medicine, Department of Nursing.
    En brinnande fråga-  Förekomst av stressrelaterade symtom och samband med krav, kontroll och socialt stöd hos brandpersonal i Sverige2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Many health and safety problems revolve around psychosocial factors. The relationship between demand, control and social support affect our health. Increased risk for mental suffering exists when low social support and low control is experienced. Working hours and lack of control can be associated with gastrointestinal- and sleeping problems. Firefighters have a dangerous occupation and many stressors affect the firefighter´s health. Few studies have investigated demand, control and support linked to stress-related symptoms at work for firefighters, it is important to investigate this though it may affect the individual, workgroup and society.

    Purpose: Identify occurrence of stress related symptoms and their relationship with demand, control and social support in Swedish firefighters.

    Method: The study was part of a cross-sectional study of firefighter's health, 476 people attended. Correlation analyzes with Spearman's korrelationskofficiens was performed.

    Results: Low prevalence of sleep- and stomach problems was seen. Correlation was found where demand and social support correlated with sleep- and stomach problems. Sleep- and stomach problems correlated significantly. Gender and stomach problems also correlated.

    Conclusion: The incidence of sleep- and stomach problems was low and participants felt relatively good. Further research on health factors of firefighters and more studies with other variables compared with demand, control and support is needed.

  • 18.
    Khan, Nida A.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Interaction of adipose derived stem cells with breast cancer cells: An in vitro study with MCF-7 breast cancer cells examining the oncological safety of autologous human adipose stem cells used in reconstructive surgery2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 19. Leask, Calum F.
    et al.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Skelton, Dawn A.
    Chastin, Sebastien F. M.
    Co-creating a tailored public health intervention to reduce older adults' sedentary behaviour2017In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 76, no 5, p. 595-608Article in journal (Refereed)
    Abstract [en]

    Objective: The increasing health care costs associated with an ageing population and chronic disease burden are largely attributable to modifiable lifestyle factors that are complex and vary between individuals and settings. Traditional approaches to promoting healthy lifestyles have so far had limited success. Recently, co-creating public health interventions with end-users has been advocated to provide more effective and sustainable solutions. The aim of this study was to document and evaluate the co-creation of a public health intervention to reduce sedentary behaviour in older adults.

    Design: Community-dwelling older adults (N = 11, mean age = 74 years) and academic researchers attended 10 interactive co-creation workshops together.

    Setting: Workshops took place on university campus and the co-creators completed fieldwork tasks outside the workshops.

    Method: Workshops were informed by the Participatory and Appreciative Action and Reflection methodology. Data were collected using field notes, video recording and worksheet tasks. Analysis was conducted using a qualitative content analysis approach.

    Results: The co-creators developed a tailored intervention delivered through a mode congruent with older adults’ lives. Key elements of the intervention included (1) education on sedentary behaviour, (2) resources to interrupt sedentary behaviour, (3) self-monitoring, (4) action planning and (5) evaluating the benefits of interrupting sedentary behaviour.

    Conclusion: Co-creation is a feasible approach to develop public health interventions; however, it is limited by the lack of a systematic framework to guide the process. Future work should aim to develop principles and recommendations to ensure co-creation can be conducted in a more scientific and reproducible way. The effectiveness and scalability of the intervention should be assessed.

  • 20. Lundström, Staffan
    et al.
    Axelsson, Bertil
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Heedman, Per-Anders
    Fransson, Greger
    Fürst, Carl Johan
    Developing a national quality register in end-of-life care: The Swedish experience2012In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 26, no 4, p. 313-321Article in journal (Refereed)
    Abstract [en]

    Background: The complexity of end-of-life care, represented by a large number of units caring for dying patients, different types of organizations and difficulties in identification and prognostication, signifies the importance of finding ways to measure the quality of end-of-life care. Aim: To establish, test and manage a national quality register for end-of-life care. Design: Two questionnaires were developed with an attempt to retrospectively identify important aspects of the care delivered during the last week in life. An internet-based IT platform was created, enabling the physician and/or nurse responsible for the care during the last week in life to register answers online. Setting: Units caring for dying people, such as hospital wards, home care units, palliative in-patient care units and nursing facilities. Results: The register received status as a National Quality Register in 2006. More than 30,000 deaths in nursing facilities, hospital wards, palliative in-patient units and private homes were registered during 2010, representing 34% of all deaths in Sweden and 58% of the cancer deaths. Conclusions: We have shown that it is feasible to establish a national quality register in end-of-life care and collect data through a web-based system. Ongoing data analyses will show in what way this initiative can lead to improved quality of life for patients and their families. There is an ongoing process internationally to define relevant outcome measures for quality of care at the end-of-life in different care settings; the registry has a potentially important role in this development.

  • 21.
    Lundälv, Jörgen
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Per-Olof
    Törnbom, Marie
    Sunnerhagen, Katharina Stibrant
    The ICF: International Classification of Functioning, Disability and Health (ICF) - A Swiss army knife? Accessibility and disability in a Scandinavian disability magazine (SDM) - A quantitative content analysis2012In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 108, no 1, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Background: The study describes the extent to which the concept of accessibility and accessibility issues has been reported in a national Scandinavian disability magazine. In this study particular attention is paid to how the compatibility between the various domains of the international classification - International Classification of Functioning, Disability and Health (ICF) - has been covered in the magazine over a decade. Furthermore, other types of descriptions that the magazine has made of accessibility for people with physical disabilities are considered. Methods: The study is based on a quantitative content analysis of a total of 326 articles from the Swedish disability magazine (SDM); 450 text pages published during the years 2000-2009. The magazine's coverage has been comprehensive. Results and conclusions: More than half of the studied texts were news items about various accessibility issues. Every third article can be characterised as a news article or feature article. The most frequently reported of the ICF domains consist of two perspectives: environmental accessibility and civil rights. Public opinion articles in the form of letters to editors and editorials focused on accessibility have a low frequency. Likewise, research reports are few. The study has included a review of illustrations and photographs. The illustrations are generally of high quality, reinforcing the disability message of the article.

  • 22.
    Malmberg, Bo
    et al.
    Institutet för gerontologi, Hälsohögskolan i Jönköping.
    Sandström, Mattias
    Umeå University, Faculty of Social Sciences, Demographic Data Base.
    Sundström, Gerdt
    Institutet för gerontologi, Hälsohögskolan i Jönköping.
    Lennartsson, Carin
    Aging Research Center (ARC) & Karolinska Institutet, Stockholm.
    När barnen går först: historiska aspekter på att förlora barn2015Report (Other academic)
  • 23.
    Martinsson, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Fürst, Carl Johan
    Lundström, Staffan
    Nathanaelsson, Lena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Axelsson, Bertil
    Registration in a quality register: a method to improve end-of-lifecare—a cross-sectional study2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 4, article id e001328Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Structured methods to assess and support improvement in the quality of end-of-life care are lacking and need to be developed. This need is particularly high outside the specialised palliative care. This study examines whether participation in a national quality register increased the quality of end-of-life care.

    DESIGN: This study is a cross-sectional longitudinal register study.

    SETTING: The Swedish Register of Palliative Care (SRPC) collects data about end-of-life care for deaths in all types of healthcare units all over Sweden. Data from all 503 healthcare units that had reported patients continuously to the register during a 3-year period were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on provided care during the last weeks of life were compared year-by-year with logistic regression.

    PARTICIPANTS: The study included a total 30 283 patients. The gender distribution was 54% women and 46% men. A total of 60% of patients in the study had a cancer diagnosis.

    RESULTS: Provided end-of-life care improved in a number of ways. The prevalence of six examined symptoms decreased. The prescription of 'as needed' medications for pain, nausea, anxiety and death rattle increased. A higher proportion of patients died in their place of preference. The patient's next of kin was more often offered a follow-up appointment after the patient's death. No changes were seen with respect to providing information to the patient or next of kin.

    CONCLUSIONS: Participation in a national quality register covariates with quality improvements in end-of-life care over time.

  • 24.
    Merrick, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Five years post whiplash injury: symptom and psychological factors in recovered versus non-recovered2010In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 3, p. 190-Article in journal (Refereed)
    Abstract [en]

    Background Few studies have focused on the differences between persons who are recovered after whiplash injury and those who suffer from persistent disability. The primary aim of this study was therefore to examine differences in symptoms, psychological factors and life satisfaction between subjects classified as recovered and those with persistent disability five years after whiplash injury based on the Neck Disability Index (NDI).

    Methods A set of questionnaires was answered by 158 persons (75 men, 83 women) to assess disability (NDI), pain intensity (VAS), whiplash-related symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), post-traumatic stress (Impact of Event Scale, IES), depression (Beck's depression inventory, BDI) and life satisfaction (LiSat-11).

    The participants were divided into three groups based on the results of the NDI: recovered (34.8%), mild disability (37.3%) and moderate/severe disability (27.3%).

    Results The moderate/severe group reported significantly higher VAS, BDI and IES scores and lower level of physical health and psychological health compared to the mild and the recovered groups. Less significant differences were reported between the mild and the recovered groups.

    Conclusions The group with the highest disability score reported most health problems with pain, symptoms, depression, post-traumatic stress and decreased life satisfaction. These findings indicate that classifying these subjects into subgroups based on disability levels makes it possible to optimize the management and treatment after whiplash injury.

  • 25.
    Mårtensson, Sophia
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Evaluation of prehospital medical management during a disaster exercise in an underground mining environment2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 26. Nygren DeBoussard, Catharina
    et al.
    Lannsjö, Marianne
    Stenberg, Maud
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Godbolt, Alison K
    Behavioural problems in the first year after Severe traumatic brain injury: a prospective multicentre study2017In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, no 4, p. 555-566Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the occurrence of behavioural problems in patients with severe traumatic brain injury during the first year after injury and potential associations with outcome. An additional post hoc objective was to analyse the frequency of behaviours with need for intervention from staff.

    DESIGN AND SETTING: In a prospective population based cohort study 114 patients with severe traumatic brain injury were assessed at three weeks, three months and one year after injury.

    MAIN MEASURES: Assessments included clinical examination and standardised instruments. Agitation was assessed with the Agitated Behaviour Scale, the course of recovery by the Rancho Los Amigo Scale and outcome by Glasgow Outcome Scale Extended.

    RESULTS: Agitation were most common at 3 weeks post injury and 28% (n=68) of the patients showed at least one agitated behaviour requiring intervention from staff. Presence of significant agitation at 3 weeks after injury was not associated with poor outcome. At 3 months agitation was present in 11% (n=90) and apathy in 26 out of 81 assessed patients. At 3 months agitation and apathy were associated with poor outcome at one year.

    CONCLUSIONS: Most agitated behaviours in the early phase are transient and are not associated with poor outcome. Agitation and apathy are uncommon at three months but when present are associated with poor outcome at one year after injury. In the early phase after a severe traumatic brain injury agitated behaviour in need of interventions from staff occur in a substantial proportion of patients.

  • 27. Olofsson, N.
    et al.
    Lindqvist, K.
    Danielsson, Ingela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Fear of crime and psychological and physical abuse associated with ill health in a Swedish population aged 65-84 years2012In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 126, no 4, p. 358-364Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the association between fear of crime and/or psychological and/or physical abuse in relation to self-reported physical and psychological health, using a large representative sample of elderly women and men in Sweden. Study design: Cross-sectional national survey. Methods: Data were taken from a nationwide representative public health survey (2006). Men and women between the ages of 65 and 84 years were selected for the present analyses (4386 men and 4974 women). The response rate for this age group was 59% for men and 70% for women. Results: Psychological and physical abuse against elderly women and men led to higher odds ratios for negative health outcomes, independently of socio-economic status. Strong correlation was found between psychological abuse and negative health outcomes in both men and women, while the correlation was less strong for physical abuse, especially among women. The men had high odds ratios for suicidal thoughts and even for attempted suicide in connection with physical and psychological abuse and fear of crime. Conclusions: The study provides representative results addressing an extensive negative health outcome panorama caused by fear of crime and exposure to abuse. (C) 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  • 28.
    Olsson, Frida
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Crash direction in relation to spine injury - The relationship between crash direction and injury to vertebrae and spinal cord of belted car occupants2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 29.
    Pietilä Holmner, Elisabeth
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Multimodal rehabilitation of patients with chronic musculoskeletal pain, focusing on primary care2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Chronic pain is a complex condition that has consequences both for individual people and for society. The individual often experiences impact on function, activity and participation. Society is affected by high healthcare and sick leave costs and a loss of workforce. Multimodal rehabilitation programmes (MMRP) have mainly been provided through specialist care but it is now also available through primary care. The overall aim of this thesis was to evaluate the effects of MMRP in patients with chronic musculoskeletal pain and to explore patients’ and healthcare professionals’ experiences of MMRP.

    Study I: Aim: To evaluate the effects of an interdisciplinary team assessment and MMRP for patients with chronic pain in a specialist care setting. Design: Longitudinal cohort study. Method: Pain intensity, pain dimensions, anxiety and depression were measured at assessment and at the start and end of MMRP.  A total of 93 women were evaluated. Result: Pain and pain-related measures were significantly improved both after the interdisciplinary assessment and after MMRP.

    Study II: Aim: To explore healthcare professionals’ experiences of MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Fourteen healthcare professionals (11 women, 3 men) were interviewed about their work with MMRP. Result: Healthcare professionals considered that MMRP was useful but also challenging. It was difficult to select appropriate patients, and health care professionals felt they were torn between following healthcare legislation and the goals of MMRP. They had to deal with ethical dilemmas as well as decide what constitutes good results.

    Study III: Aim: To explore patients’ experiences of participating in MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Twelve former patients (7 women and 5 men) were interviewed about their experiences of MMRP in primary care. Result: Patients in primary care experienced a complex, ongoing process of accepting chronic pain. Obtaining redress, learning about chronic pain, and experiencing fellowship with others with the same condition contributed to the acceptance process.

    Study IV: Aim: To evaluate the effects of MMRP in primary care at one-year follow-up for all patients together and for men and women separately and to identify predictive factors for being employable at follow-up. Design: Prospective longitudinal cohort study. Method: Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sick leave extent and sickness compensation were evaluated prior to and one year after MMRP in 234 patients, 34 men and 200 women. Result: All patients improved significantly in most measures at one-year follow-up, and the effect was larger in women. Sick leave decreased while no significant difference was found for total sickness compensation. Patients’ self-reported rating of current work ability before MMRP was significantly associated with being employable at follow-up.

    General conclusions and implications: 

    MMRP seems to be effective for patients with chronic musculoskeletal pain, both in specialist care and in primary care. MMRP was more effective for women than for men, and the reasons for this need to be investigated further. An interdisciplinary team assessment could also be beneficial for decreasing pain and pain-related measures. Patients in primary care experience a complex, ongoing process of accepting chronic pain. Healthcare professionals have to deal with conflicting emotions with regard to different commitments from healthcare legislation and the goals of MMRP.                         

  • 30.
    Pietilä Holmner, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Enthoven, Paul
    Stenberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    "The acceptance" of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 1, p. 73-79Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore patient experiences of participating in multimodal pain rehabilitation in primary care.

    SUBJECTS: Twelve former patients (7 women and 5 men) in multimodal rehabilitation in primary care were interviewed about their experiences of multimodal rehabilitation.

    METHODS: The interviews were analysed using qualitative content analysis.

    RESULTS: Analysis resulted in 4 categories: (i) from discredited towards obtaining redress; (ii) from uncertainty towards knowledge; (iii) from loneliness towards togetherness; and (iv) "acceptance of pain": an ongoing process. The results show that having obtained redress, to obtain knowledge about chronic pain, and to experience fellowship with others with the same condition were helpful in the acceptance process. However, there were patients who found it difficult to reconcile themselves with a life with chronic pain after multimodal rehabilitation. To find what was "wrong" and to have a medical diagnosis and cure were important.

    CONCLUSION: Patients in primary care multimodal rehabilitation experience a complex, ongoing process of accepting chronic pain. Four important categories were described. These findings will help others to understand the experience and perspective of patients with chronic pain who engage in multimodal rehabilitation.

  • 31.
    Rajalin, Mia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hirvikoski, Tatja
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Karolinska Univ Hosp, Karolinska Inst, Dept Clin Neurosci Psychiat, SE-17176 Stockholm, Sweden.
    DBT-based skills training for family members of suicidal patients: open clinical feasibility trial in a psychiatric outpatient contextManuscript (preprint) (Other academic)
    Abstract [en]

    The involvement of significant others is an objective in suicide prevention and there is a need for development of interventions for this group. The aim of this open naturalistic study was to evaluate the feasibility and the preliminary efficacy of Family Connections (FC) for significant others of suicidal patients, a nine-week manualized skills training program based on dialectical behavior therapy (DBT) in a clinical context.

    The intervention program aims to enhance the knowledge of symptoms and behaviors connected with attempted suicide. Furthermore it introduces stress-coping strategies and emotion regulation skills. Out of 132 participants in total, 104 (79%) completed the program. Included in the analysis were the 86 (65%) participants who completed the program, and who also had both pre- and post-intervention assessments. The Burden assessment scale, BAS, the Questions About Family Members scale, QAFM, and the Five Facet Mindfulness Questionnaire, FFMQ, were used to assess perceived burden, relationship climate and five facets of mindfulness respectively.

    The results showed a significant reduction in perceived burden, measured by BAS, and a significant change in the mindfulness scale FFMQ subscale Acting with Awareness, which indicates an enhanced ability to be present in the moment. None of the four subscales in QAFM showed significant changes between the pre- and post-intervention assessments.

    The results support the feasibility and potential value of the implementation of an intervention for family members and friends of suicidal patients in psychiatric care. Randomized controlled studies are needed to generate further evidence.

  • 32.
    Rajalin, Mia
    et al.
    Södermalm Psychiatric Out patient Services, Stockholm County Council; Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Wickholm-Pethrus, Lina
    Hursti, Timo
    Uppsala universitet, Institutionen för psykologi.
    Jokinen, Jussi
    Karolinska Univ Hosp, Karolinska Inst, Dept Clin Neurosci Psychiat, Stockholm, Sweden.
    Dialectical Behavior Therapy-Based Skills Training for Family Members of Suicide Attempters2009In: Archives of Suicide Research, ISSN 1381-1118, E-ISSN 1573-8159, Vol. 13, p. 257-263Article in journal (Refereed)
    Abstract [en]

    This pilot study evaluated the effect of Family Connections (FC), a Dialectical Behavior Therapy-based manualized skills training program, for family members of suicide attempters. The DBT-based skills training program aims to enhance the knowledge of wide range research based aspects of suicidal behavior and treatment recommendations. Furthermore it includes skills training for interpersonal relationships and also offers family members an opportunity to share their experiences. Thirteen participants completed the 9-week program with pre- and post selfreport questionnaires. The results showed significant reduction in burden, improved psychic health and an increase in well-being regarding the relation with the patient. These results provide support for the need and importance of a DBT-based skills training program addressed specifically to family members of suicide attempters.

  • 33. Religa, Dorota
    et al.
    Fereshtehnejad, Seyed-Mohammad
    Cermakova, Pavla
    Edlund, Ann-Katrin
    Garcia-Ptacek, Sara
    Granqvist, Nicklas
    Hallbäck, Anne
    Kåwe, Kerstin
    Farahmand, Bahman
    Kilander, Lena
    Mattsson, Ulla-Britt
    Nägga, Katarina
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Wijk, Helle
    Wimo, Anders
    Winblad, Bengt
    Eriksdotter, Maria
    SveDem, the Swedish dementia registry: a tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 2, article id e0116538Article in journal (Refereed)
    Abstract [en]

    Background: The Swedish Dementia Registry (SveDem) was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden. Methods: SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se). The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes. Results: The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to informmedical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden. Conclusion: SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.

  • 34.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Why "spirituality" instead of "the humanistic side of medicine"?2014In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 89, no 11, p. 1430-1430Article in journal (Other academic)
  • 35. Selander, John
    et al.
    Marnetoft, Sven-Uno
    Åsell, Malin
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Predictors for successful vocational rehabilitation for clients with back pain problems2007In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, no 3, p. 215-220Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to identify predicting factors for successful vocational rehabilitation for people with back pain problems.

    METHOD: The study was based on data from 347 long-term sick-listed clients collected at the onset of vocational rehabilitation. The outcome was measured 6 months after the conclusion of rehabilitation.

    RESULTS: In a first bi-variate analysis, a considerable number of variables were associated with the rehabilitation outcome. In a second multivariate analysis, only four associations remained. These were age, general health, vitality and internal locus of control. Young vital clients in good general health, with a high internal locus of control were more likely than others to return to work.

    CONCLUSION: The findings regarding age, general health and vitality are well in line with previous studies. The findings regarding internal locus of control are more unique.

  • 36.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Edlund, Curt
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Falkdal, Annie H.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Swedish Association of Local Authorities and Regions, Stockholm, Sweden.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Healthcare encounters and return to work: a qualitative study on sick-listed patients' experiences2014In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 4, p. 464-475Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sickness absence is a complex phenomenon affected by aspects other than disease. One important factor that can affect sick leave is the individual's experience of healthcare encounters. It is therefore essential to consider the quality of the encounter with health professionals and its impact on the patient's rehabilitation and return to work.

    AIM: The aim was to explore how sick-listed patients in Sweden perceive their contact with healthcare professionals in primary healthcare and to analyse what they view as crucial components for returning to work.

    METHODS: A qualitative approach was used. Data were collected by semi-structured telephonic interviews with patients who were or had been on sick leave. The transcribed interview text was analysed according to qualitative content analysis.

    FINDINGS: The analysis revealed two themes that highlight important areas for persons on sick leave in their healthcare encounters. The theme 'Trust in the relationship' contains categories describing the patients' feelings of participation, and of being believed, confirmed, and listened to, and also dedication on the part of healthcare providers. Healthcare encounters that were characterised by professionalism, knowledge, continuity, and a holistic approach seemed to create trust. The theme 'Structure and balance' contains the participants' views on important factors that could support the return-to-work process. All participants stated the importance of follow-up and a plan for rehabilitation. Sick leave itself can make a person passive, and participants in this study asked for support to balance activity, exercise, and work demands, which could facilitate their return to work.

    CONCLUSION: Healthcare professionals can facilitate sick-listed persons' rehabilitation back to work by providing a clear structure in the process and support in occupational balance. The healthcare encounters must build on a mutual trust.

  • 37.
    Svensson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Suarez, Nivia Carballeira
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Parents' experiences of having and caring for a child with an eating disorder2013In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 21, no 5, p. 395-407Article in journal (Refereed)
    Abstract [en]

    Eating disorders (ED) are serious conditions that affect both patients and their families. Little is known about the influence of these disorders on family life in a Swedish population and the ways that affected families actually attempt to cope. The aim of this study was to specifically investigate parental experiences of having and caring for a child with ED. A qualitative approach was used and rich narratives were obtained from interviews with 10 parents. Results promote insights into lived experiences concerning social disruption, emotional impact, and coping strategies related to ED. This knowledge can be utilized to further develop programs to help affected families.

  • 38.
    van Doorn, Janis
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Ahlinder, Annie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Labba, Julia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Development of a speech assessment tool (SIV) for use by health professionals who work with DBS patients2013In: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 28, no Suppl 1, p. S452-S453Article in journal (Refereed)
  • 39.
    Waller, Simon
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    The presence of post-concussion symptoms among Swedish elite female football players2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 40.
    Weidung, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Department of Public Health and Caring Sciences, Geriatric Medicine, Uppsala University, Uppsala.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Systolic blood pressure decline in very old individuals is explained by deteriorating health: Longitudinal changes from Umea85+/GERDA2017In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 51, article id e9161Article in journal (Refereed)
    Abstract [en]

    Declining systolic blood pressure (SBP) is common in very old age and is associated with adverse events, such as dementia. Knowledge of factors associated with SBP changes could explain the etiology of this decline in SBP. This study investigated longitudinal changes in socioeconomic factors, medical conditions, drug prescriptions, and assessments and their associations with SBP changes among very old followed individuals.The study was based on data from the Umea85+/Gerontological Regional Database (GERDA) cohort study, which provided cross-sectional and longitudinal data on participants aged 85, 90, and 95 years from 2000 to 2015. Follow-up assessments were conducted after 5 years. The main outcome was a change in SBP. Factors associated with SBP changes were assessed using multivariate linear regression models.In the Umea85+/GERDA study, 454 surviving individuals underwent follow-up assessment after 5 years. Of these, 297 had SBP measured at baseline and follow-up. The mean changestandard deviation in SBP was -12 +/- 25mm Hg. SBP decline was associated independently with later investigation year (P=.009), higher baseline SBP (P<.001), baseline antidepressant prescription (P=.011), incident acute myocardial infarction during follow-up (P=.003), new diuretic prescription during follow-up (P=.044), and a decline in the Barthel Activities of Daily Living index at follow-up (P<.001).In conclusion, SBP declines among very old individuals. This decline seems to be associated with initial SBP level, investigation year, and health-related factors.

  • 41.
    Wiklund, Robert
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Risk factors for hip fracture in very old people: a population-based study2016In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, no 3, p. 923-931Article in journal (Refereed)
    Abstract [en]

    Knowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson's disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development.

    INTRODUCTION: The purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people.

    METHODS: In total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression.

    RESULTS: Participants had a mean age of 89.3 ± 4.7 years; 65.8 % were women, 36.8 % lived in residential care facilities, 33.6 % had dementia, and 20.4 % had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1 %) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR] = 8.57; 95 % confidence interval [CI], 1.90-38.71), Parkinson's disease (HR = 5.12; 95 % CI, 1.82-14.44), currently smoking (HR = 4.38; 95 % CI 2.06-9.33), delirium in the previous month (HR = 2.01; 95 % CI, 1.15-3.49), underweight (body mass index <22; HR = 1.74, 95 % CI, 1.09-2.77), and age (HR = 1.09; 95 % CI, 1.04-1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR = 0.37; 95 % CI, 0.15-0.91), but only for those with bilateral hip prostheses.

    CONCLUSIONS: Seven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.

  • 42. Zhuo, Lang
    et al.
    Xu, Ling
    Ye, Jingtao
    Sun, Sun
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Health Outcomes and Economic Evaluation Research Group, Stockholm, Sweden; Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Zhang, Yaoguang
    Burstrom, Kristina
    Chen, Jiaying
    Time Trade-Off Value Set for EQ-5D-3L Based on a Nationally Representative Chinese Population Survey2018In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, no 11, p. 1330-1337Article in journal (Refereed)
    Abstract [en]

    Objectives: To obtain a nationally representative Chinese three-level EuroQol five-dimensional questionnaire value set based on the time trade-off (TTO) method.

    Methods: A multistage, stratified, clustered random nationally representative Chinese sample was used. The study design followed an adapted UK Measurement and Valuation of Health protocol. Each respondent valued 11 random states plus state 33333 and "unconscious" using the TTO method in face-to-face interviews. Three types of models were explored: ordinary least squares, general least squares, and weighted least squares models.

    Results: In total, 5939 inhabitants aged 15 years and older were interviewed. Of these, 5503 satisfactorily interviewed participants were included in constructing models. An ordinary least squares model including 10 dummies without constant and N3 had a mean absolute error of 0.083 and a correlation coefficient of 0.899 between the predicted and mean values. Goodness-of-fit indices of two models based on split subsample were similar.

    Conclusions: TTO values were higher in our study compared with those in a study carried out in urban areas, which is mirrored by the higher values in rural areas. Several other aspects, in addition to the valuation procedure, might have influenced the results, such as factors beyond demographic factors such as view on life and death and believing in an afterlife, which need further investigation. Future studies using the three-level EuroQol five-dimensional questionnaire should consider using this value set based on a nationally representative sample of the Chinese population.

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